Случай манифестации острого миелоидного лейкоза у подростка на фоне коронавирусной инфекции COVID-19

This clinical case describes the manifestation of acute myeloid leukemia (AML) against the backdrop of severe COVID-19 infection in a teenage patient. The patient’s examination data, medical history, and available scientific literature on the relationship between COVID-19 and leukemia manifestation were studied and analyzed. COVID-19 infection in the context of AML was severe, with respiratory failure and involvement of more than 90% of the lungs according to computed tomography data. Changes observed in peripheral blood did not have specific alterations and only indirectly indicated an unfavorable premorbid background. This clinical case reflects the likelihood of the simultaneous presence of COVID-19 and other acute severe illnesses.Данный клинический случай описывает манифестацию острого миелоидного лейкоза на фоне тяжелого течения коронавирусной инфекции COVID-19 у пациентки подросткового возраста. Изучены и проанализированы данные обследований пациентки, анамнез жизни и заболевания, произведен анализ имеющейся научной литературы, посвященной взаимосвязи COVID-19 с манифестацией лейкоза. Коронавирусная инфекция COVID-19 на фоне острого миелоидного лейкоза протекала в тяжелой форме, с дыхательной недостаточностью и вовлечением в патологический процесс более 90% лёгких по данным компьютерной томографии. Изменения, наблюдаемые в периферической крови, не имели специфических изменений и лишь косвенно указывали на неблагоприятный преморбидный фон. Клинический случай отражает вероятность существования одновременно коронавирусной инфекции COVID-19 и других острых тяжелых заболеваний

Эффективность вакцинации против COVID-19 в организованном коллективе: результаты проспективного исследования

   Objective: to assess the efficacy of COVID-19 vaccination against in organized group.   Materials and methods: A total of 122 adults, employees of a higher education institution participated in the study. Study participants were observed prospectively and filled out a questionnaire where they indicated their age, presence of chronic diseases, history of COVID-19 and vaccination status.   Findings: the study participants were divided into two groups: 59 vaccinated (48.36 %) and 63 unvaccinated (51.64 %) individuals with no differences in age between the groups. There were significantly fewer confirmed cases of COVID-19 in the vaccinated group (р = 0,0008457, df = 1; χ2 = 11,138), significant differences (p = 0.0084; df = 4; χ2 =13.678) were observed in the number of cases among study participants based on their vaccination status.   Conclusion: participants diagnosed with pneumonia were 75 % unvaccinated (p = 0,00729; df = 1; χ2 = 7,2). All hospitalized study participants were unvaccinated (p = 0,004678; χ2 =8,0). None of the vaccinated participants needed respiratory support (p = 0,0455; df = 1; χ2 = 4,0). Chronic disease in vaccinated subjects made a significant (p = 0,04563; df = 2; χ2 = 6,1743) impact on COVID-19 severity.   Цель: оценить эффективность вакцинации против COVID-19 в организованном коллективе.   Материалы и методы: в исследовании приняли участие 122 взрослых, сотрудников учреждения высшего образования. Участники исследования наблюдались проспективно, а также заполнили анкету, в которой указали возраст, наличие хронических заболеваний, анамнез по COVID-19 и статус вакцинации.   Результаты: участники исследования были разделены на две группы: 59 вакцинированных (48,36 %) и 63 невакцинированных (51,64 %) человека без различий в возрасте между группами. В группе вакцинированных было значительно меньше подтвержденных случаев COVID-19 (р = 0,0008457, df = 1; χ2 = 11,138), значительные различия (p = 0,0084; df = 4; χ2 = 13,678) наблюдались в количестве случаев заболевания среди участников исследования с учетом их статуса вакцинации.   Заключение: участники с диагнозом «Пневмония» в 75 % случаев были невакцинированными (p = 0,00729; df = 1; χ2 =7,2). Все госпитализированные участники исследования были не вакцинированы (p = 0,004678; χ2 =8,0). Ни один из вакцинированных участников не нуждался в респираторной поддержке (p = 0,0455; df = 1; χ2 = 4,0). Хронические заболевания у вакцинированных оказывали значимое (p = 0,04563; df = 2; χ2 = 6,1743) влияние на тяжесть COVID-19

Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study

Objectives Mortality among HIV patients with tuberculosis (TB) remains high in Eastern Europe (EE), but details of TB and HIV management remain scarce. Methods In this prospective study, we describe the TB treatment regimens of patients with multi-drug resistant (MDR) TB and use of antiretroviral therapy (ART). Results A total of 105 HIV-positive patients had MDR-TB (including 33 with extensive drug resistance) and 130 pan-susceptible TB. Adequate initial TB treatment was provided for 8% of patients with MDR-TB compared with 80% of those with pan-susceptible TB. By twelve months, an estimated 57.3% (95%CI 41.5\u201374.1) of MDR-TB patients had started adequate treatment. While 67% received ART, HIV-RNA suppression was demonstrated in only 23%. Conclusions Our results show that internationally recommended MDR-TB treatment regimens were infrequently used and that ART use and viral suppression was well below the target of 90%, reflecting the challenging patient population and the environment in which health care is provided. Urgent improvement of management of patients with TB/HIV in EE, in particular for those with MDR-TB, is needed and includes widespread access to rapid TB diagnostics, better access to and use of second-line TB drugs, timely ART initiation with viral load monitoring, and integration of TB/HIV care

Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study

Objectives Mortality among HIV patients with tuberculosis (TB) remains high in Eastern Europe (EE), but details of TB and HIV management remain scarce. Methods In this prospective study, we describe the TB treatment regimens of patients with multi-drug resistant (MDR) TB and use of antiretroviral therapy (ART). Results A total of 105 HIV-positive patients had MDR-TB (including 33 with extensive drug resistance) and 130 pan-susceptible TB. Adequate initial TB treatment was provided for 8% of patients with MDR-TB compared with 80% of those with pan-susceptible TB. By twelve months, an estimated 57.3% (95%CI 41.5–74.1) of MDR-TB patients had started adequate treatment. While 67% received ART, HIV-RNA suppression was demonstrated in only 23%. Conclusions Our results show that internationally recommended MDR-TB treatment regimens were infrequently used and that ART use and viral suppression was well below the target of 90%, reflecting the challenging patient population and the environment in which health care is provided. Urgent improvement of management of patients with TB/HIV in EE, in particular for those with MDR-TB, is needed and includes widespread access to rapid TB diagnostics, better access to and use of second-line TB drugs, timely ART initiation with viral load monitoring, and integration of TB/HIV care

Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study

Objectives Mortality among HIV patients with tuberculosis (TB) remains high in Eastern Europe (EE), but details of TB and HIV management remain scarce. Methods In this prospective study, we describe the TB treatment regimens of patients with multi-drug resistant (MDR) TB and use of antiretroviral therapy (ART). Results A total of 105 HIV-positive patients had MDR-TB (including 33 with extensive drug resistance) and 130 pan-susceptible TB. Adequate initial TB treatment was provided for 8% of patients with MDR-TB compared with 80% of those with pan-susceptible TB. By twelve months, an estimated 57.3% (95%CI 41.5–74.1) of MDR-TB patients had started adequate treatment. While 67% received ART, HIV-RNA suppression was demonstrated in only 23%. Conclusions Our results show that internationally recommended MDR-TB treatment regimens were infrequently used and that ART use and viral suppression was well below the target of 90%, reflecting the challenging patient population and the environment in which health care is provided. Urgent improvement of management of patients with TB/HIV in EE, in particular for those with MDR-TB, is needed and includes widespread access to rapid TB diagnostics, better access to and use of second-line TB drugs, timely ART initiation with viral load monitoring, and integration of TB/HIV care

Delayed diagnosis of tuberculosis in persons living with HIV in Eastern Europe: associated factors and effect on mortality—a multicentre prospective cohort study

Background: Early diagnosis of tuberculosis (TB) is important to reduce transmission, morbidity and mortality in people living with HIV (PLWH). Methods: PLWH with a diagnosis of TB were enrolled from HIV and TB clinics in Eastern Europe and followed until 24 months. Delayed diagnosis was defined as duration of TB symptoms (cough, weight-loss or fever) for ≥ 1 month before TB diagnosis. Risk factors for delayed TB diagnosis were assessed using multivariable logistic regression. The effect of delayed diagnosis on mortality was assessed using Kaplan–Meier estimates and Cox models. Findings: 480/740 patients (64.9%; 95% CI 61.3–68.3%) experienced a delayed diagnosis. Age ≥ 50 years (vs. < 50 years, aOR = 2.51; 1.18–5.32; p = 0.016), injecting drug use (IDU) (vs. non-IDU aOR = 1.66; 1.21–2.29; p = 0.002), being ART naïve (aOR = 1.77; 1.24–2.54; p = 0.002), disseminated TB (vs. pulmonary TB, aOR = 1.56, 1.10–2.19, p = 0.012), and presenting with weight loss (vs. no weight loss, aOR = 1.63; 1.18–2.24; p = 0.003) were associated with delayed diagnosis. PLWH with a delayed diagnosis were at 36% increased risk of death (hazard ratio = 1.36; 1.04–1.77; p = 0.023, adjusted hazard ratio 1.27; 0.95–1.70; p = 0.103). Conclusion: Nearly two thirds of PLWH with TB in Eastern Europe had a delayed TB diagnosis, in particular those of older age, people who inject drugs, ART naïve, with disseminated disease, and presenting with weight loss. Patients with delayed TB diagnosis were subsequently at higher risk of death in unadjusted analysis. There is a need for optimisation of the current TB diagnostic cascade and HIV care in PLWH in Eastern Europe

Delayed diagnosis of tuberculosis in persons living with HIV in Eastern Europe : associated factors and effect on mortality-a multicentre prospective cohort study

Background: Early diagnosis of tuberculosis (TB) is important to reduce transmission, morbidity and mortality in people living with HIV (PLWH). Methods: PLWH with a diagnosis of TB were enrolled from HIV and TB clinics in Eastern Europe and followed until 24 months. Delayed diagnosis was defined as duration of TB symptoms (cough, weight-loss or fever) for ≥ 1 month before TB diagnosis. Risk factors for delayed TB diagnosis were assessed using multivariable logistic regression. The effect of delayed diagnosis on mortality was assessed using Kaplan-Meier estimates and Cox models. Findings: 480/740 patients (64.9%; 95% CI 61.3-68.3%) experienced a delayed diagnosis. Age ≥ 50 years (vs. < 50 years, aOR = 2.51; 1.18-5.32; p = 0.016), injecting drug use (IDU) (vs. non-IDU aOR = 1.66; 1.21-2.29; p = 0.002), being ART naïve (aOR = 1.77; 1.24-2.54; p = 0.002), disseminated TB (vs. pulmonary TB, aOR = 1.56, 1.10-2.19, p = 0.012), and presenting with weight loss (vs. no weight loss, aOR = 1.63; 1.18-2.24; p = 0.003) were associated with delayed diagnosis. PLWH with a delayed diagnosis were at 36% increased risk of death (hazard ratio = 1.36; 1.04-1.77; p = 0.023, adjusted hazard ratio 1.27; 0.95-1.70; p = 0.103). Conclusion: Nearly two thirds of PLWH with TB in Eastern Europe had a delayed TB diagnosis, in particular those of older age, people who inject drugs, ART naïve, with disseminated disease, and presenting with weight loss. Patients with delayed TB diagnosis were subsequently at higher risk of death in unadjusted analysis. There is a need for optimisation of the current TB diagnostic cascade and HIV care in PLWH in Eastern Europe